Provider Demographics
NPI:1417386574
Name:MULTIPURPOSE SENIOR SERVICES PROGRAM
Entity Type:Organization
Organization Name:MULTIPURPOSE SENIOR SERVICES PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:707-468-9347
Mailing Address - Street 1:301 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4906
Mailing Address - Country:US
Mailing Address - Phone:707-468-9347
Mailing Address - Fax:707-468-5234
Practice Address - Street 1:301 S STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4906
Practice Address - Country:US
Practice Address - Phone:707-468-9347
Practice Address - Fax:707-468-5234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE MANAGEMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management